Managing Grief: Essential Counseling Interventions

This episode was pre recorded as part of a live continuing education webinar on demand. CEUs are still available for this presentation through all CEUs register@allceus.com counselortoolbox you I'd like to welcome everybody today's presentation. This is the ongoing series for the Journey to Recovery text. Today we're going to be talking about grief and loss activities. We're going to define grief. I know you're like, well, we already know what that is and we probably do, but we're going to hit the highlights. We'll conceptualize it in terms of any loss, not just a death. We'll identify how failure to deal with grief can impact a person, explore the stages of grief, and review activities and interventions to help people grieve. So the first part is really a psycho educational part. And then the second part, we're going to be talking about those activities and hopefully I'll be giving you some useful. I don't think grief activities are ever fun, but give you some useful activities for helping your clients work through stuff. So just brainstorming, kind of off the top of your head, what types of things have people lost that need to be grieved? You know, obviously they lose. We love lose loved ones, you know, that needs to be grieved. We lose pets. That needs to be grieved. But what else? What other types of losses are we talking about here? Childhood innocence. Oh, that's so true. And that can be just because as we grow up, we do lose that innocence. I know my son, really, and he told me he articulated it quite well when I was talking to him about taking responsibility and all that kind of stuff. He's like, no, mom, I really want to stay a kid as long as I possibly can. I'm like, oh, okay. Well, good. My daughter, on the other hand, wants to graduate with her bachelor's before she's 18. So opposite ends of the spectrum. Loss of physical health, loss of marriages, jobs, independence, physical or financial or social, loss of lifestyle. And that can be because of a change in financial circumstances or a change in physical circumstances or a lot of different things. Oh, memory. I hadn't thought of that one. But as we start to lose memory, people who start developing dementia, people who have early onset Alzheimer's, or even people who have traumatic brain injury from a car accident or a football accident can lose memory and loss of health. We will talk about chronic health conditions. So yeah, you guys are on board with the fact that there's a lot of stuff out there that can be grieved grief is a label assigned to all of the emotions associated with dealing with any kind of loss. So it's a big one out there. Physically, we can lose things. Anything that's tangible, and I hate to have things in there and people. But when we lose our pets, when we lose our family members, when we lose, you know, maybe after a. After the hurricane there was a flood and your photo albums all got destroyed by the floodwaters, that can be devastating because those were your memories. So there are things that can be grieved. We can lose abilities. Whether I know right now, you know, I'm at that age, as they say, where I'm having to start wearing reading glasses all the time. And it's so frustrating to me that I can't see like I used to be able to see. But that's, you know, minuscule in compared to other things. If somebody has an accident or a stroke and has partial paralysis or something, we can lose freedoms. And that can be because the person goes to jail or the person gets put on probation. You know, there's a lot of different things that can happen. We can lose freedoms because of changes in the political environment. So, you know, you may not have the freedom to do something that you used to because they've changed the laws. So there are a lot of things that we can. We can lose self concept, we can lose roles, so to speak. For example, someone who has a baby and that baby passes away and they don't have any other children, you know, in a sense, they lost that role of being a parent. Yes, they were a parent for a period of time, but sometimes they shut that out. When we get older and our children grow up and leave the house and there's that empty nest. Am I still a mom? Yeah, I'm still a mom. But my daily activities, my role as a mom has changed significantly. I'm not changing diapers anymore and expected to make meals and those sorts of things. So that role changes and there's a grieving process. My son pointed out very, very well that he was grieving the loss of his or the ending of his childhood because he started college and, you know, at a certain point you just gotta do it. So changing that role, I mean, he fought it tooth and nail, but once he decided that that chapter was over and the next chapter was starting, he was all on board. So, you know, we have to allow people to go through these activities. We can lose values. You know, we can have a value about something. You know, maybe we value our independence, maybe we value honesty and because we're in a situation, we're acting against those values. So it may impact our self concept, worldview, our view of innocence, and our view of safety. When we're children, you know, we see the world with these big eyes and we're optimistic and when we are older, we've had other experiences. So we tend to see, you know, cognitively we're more advanced so we can think more abstractly and we're thinking less in all or nothing terms, but we can see that things aren't quite as clear as we thought and we may lose some of that innocence and that thought that, you know, people are genuinely good and out there to help us. And, you know, I'm Rogerian by nature. I think we are generally good. But there are people in the world that do bad things and it's hard when you come to that realization. People can also lose their, their innocence when they're exposed to things that, you know, they probably didn't need to ever be exposed to. We can lose our sense of safety in those same situations. I shared with you before when I was in college, unfortunately was the same time that Danny Rowling was in Gainesville. And, you know, our sense of safety on campus was just obliterated because there was this serial killer running rampant. And, you know, we were, we thought we were in this like nice little bubble and that just wasn't how it was. And it took us a while to reorganize around that and grieve the loss of the, the fact that, you know, we can't just go out and run at 10 o' clock at night or whatever. We can lose our dreams or our ideas about how things should be. You know, you may have been going along and you had this dream out here and then all of a sudden life threw you a curveball and that dream was not going to happen. Two teenagers, they're dating in high school and the female gets pregnant and, you know, we're just going to use that stereotypical cliche couple that the football star is the dad and now that he's going to be a dad, his plans for going to college and yada yada and becoming a football star there and everything, he has to really reconsider those. And sometimes he scraps them, sometimes he goes with them. That's his choice. But things like that, unexpected life changes can really alter our dreams and we need to figure out what we're going to do next. Our dreams can be altered just by reality because you may get into something and, you know, think, you know, I'M in this, I'm going to medical school and then realize all of a sudden, you know what? I can't do this. Calculus and organic chemistry is just kicking my butt. This is not something that I can do. So that dream of going to medical school, well, that's kind of shattered into a million pieces. So then you've got to figure out what else can I do? You know, when one door closes, another door opens, so to speak. But we do need to help people grieve this loss. If they've always envisioned themselves being a mother, for example, and then they find out they're infertile, that's something to be grieved. And socially, we can lose relationships. You know, friendships, love relationships. We can also lose our goes on with self concept. But we can lose our self esteem and our relationship with ourselves, especially if we start becoming inauthentic and just trying to please everyone else and we've lost our sense of self. And getting that back can be difficult. Sometimes when people are in relationships, if they've got poor, poor boundaries, they may lose themselves. So they become, you know, so and so's husband, so and so's father, so and so's whatever. But they are not Jim anymore. And they forget. I've worked with a lot of clients with addictions who don't even know who they are anymore. They don't have a relationship with themself. They just see themselves as Sally the addict or Sally the alcoholic. And I'm like, okay, there's more to you than that. So let's talk about this. And yes, Bill points out, and whether you lose a job or retirement, one of the hardest things about retirement is losing those social connections and social supports and the routine even that you had at work. You know, you may not need the money, you may be set really well or whatever, but there are losses that go along with not working there anymore. Primary losses also produce secondary losses which need to be acknowledged and grieved. So if we lose a job, for example, you know, we may be losing a part of ourself. You know, if I were to retire today, you know, I would no longer be an instructor. I would no longer be a therapist. Well, you know, that that's kind of a part of me, a loss of self confidence. You know, we can lose that because something happens and we don't handle it well. We can lose our chosen lifestyle, a sense of security or safety, and dreams. So we're going to talk about these in a second. So what secondary losses might occur for these events. And I Have them. I think you can see over here loss of ourselves, identity, self concept, lifestyle, security, dreams. A parent dies. So when your parent dies, you know, and for a lot of us it happens, sometimes it happens earlier than we really want. How is it that we're losing a part of ourself too? You know, because all of a sudden we don't have this parent, our life. A loss of a sense of identity, being a caregiver maybe for that parent, a loss of a sense of safety. Because all of a sudden, even though you're a grown up, you know, a lot of us still call mom or dad, you know, occasionally and get advice or whatever. And all of a sudden you're flopping out there going, I don't have anybody left in my, in my family, you know, and that's kind of a kick in the gut sometimes when people are like, well, where does your family live? And you're like, I don't have any left. So that's something that may need to be grieved after a separation or a divorce, you know, again, our identity changes. You're no longer, I mean, assuming that you still had your own identity, but you're also that other role that you had as so and so's spouse. Well, you're not a spouse anymore, so that's gone and figuring out how to deal with that and you've got a new identity of being a single person or a, or a widower or whatever it is. You may have lost some self confidence because of how that relationship went away. You may have lost a sense of security because there's not the financial support that you had, you know, when it was a two income family. You may have lost a sense of security because of how that relationship ended. Maybe you found out that your spouse was unfaithful and that's what ended the relationship. Or you found out that your spouse had a wicked gambling problem and had drained your bank accounts. You know, that is, you know, that shakes your world because you had this vision of a perfect marriage or pseudo perfect marriage, however it was. And then all of a sudden you find out that nothing is as it seemed. So you start questioning yourself, you start questioning other people, you start questioning your worldview. And you know, some of the dreams probably go out the window at that point too because life has taken, you know, a hard left turn. Miscarriages, you know, that's a loss of a little human being. So obviously that's devastating. But not only are you losing a human being, you're losing, like I said earlier, that sense of the ability, the blessing of getting to raise a child. You know, the dreams and how you saw bathing and feeding and changing and all that stuff. And I will add here, and I don't know if it's the same for men, but for many women, if they have to have a hysterectomy, especially if they have to have a hysterectomy when they're still able to bear children, that can be very traumatic, too, because it rips that ability away from them. And you know that those dreams of being able to have one more child just kind of go out the window. Disability can cause a lot of secondary losses because it may not only do you lose some sort of physical functioning, but you may also lose your employment or you may lose certain relationships. You know, not all relationships can stand stressors. You may lose a sense of trust and faith in your own body. You may lose comfort because you've got some chronic pain. You may lose financial security because you've got a lot of new medical bills that you've got to handle. I mean, there are a lot of things, you know, we really want to think broadly when we're thinking about losses with chronic pain, and that kind of goes along with disability. But with chronic pain, people have lost that ability to get up every morning and say, I feel great. You know, because more often than not, it's, I feel better than I did yesterday, or, you know, my pain is manageable today instead of I'm pain free manageable today. And there can be some frustration with that. With diabetes and Crohn's, people have to start changing how they eat. As Americans, we love food. We love food. So when people have to start giving up certain foods or really strictly monitoring certain foods because their body isn't doing what they think it's supposed to or what it should, should, or however you want to say it, it's frustrating. It's like you're fighting a war and living inside the battlefield. And so people with diabetes and Crohn's may look back and be frustrated and grieve how it used to be when they used to be able to eat anything they wanted and it didn't upset their stomach, or they used to be able to eat anything they wanted without having to check their blood sugar and take insulin and all this stuff. Loss of a job, moving to a new place, a child leaving home, house fires and tornadoes, Any sort of natural disaster or disaster that's displacing, you know, it destroys your home. Well, let's think about home. What does that Mean when you've got a home. Yes. You've got a secure place to sleep. You've got a roof over your head. That is true. But what else does home mean? Home has memories in it. I know we're trying to sell the first house we ever owned where both of my children were born and brought home from the hospital. And I mean, I walk through there and there are all these memories, and I'm just like, oh, I don't want to get. I don't want to sell the house. But. So, I mean, even choosing to do something can be a little bit traumatic. But when it's just ripped out from you, you know, your memories are there. A home is. You live in a neighborhood in a home. And if it's destroyed, then you're probably going to have to relocate, which means you're going to lose your neighbors and that social support system. You probably lost other stuff that was important to you. You may have lost your sense of safety because of how the home was destroyed, whether it was fire or tornado or whatever. So we do want to recognize that there are a lot of things when people lose their homes, like after a hurricane and they become displaced, especially if they're displaced a ways away from where they originally lived. They may also lose their jobs. During Katrina and probably during Harvey. I wasn't down in Texas, and I'm sure with Florence, people were displaced way far away from their actual residences, and those businesses that were in those areas were destroyed, too. So then they were losing their financial stability and, you know, and living in a shelter in and of itself is a stressful situation. So there are a lot of things that we really want to think about. And Brandy points out, during a house fire or tornado, we can also lose family, whether it's pets or family members. So there can. There are a lot of things to be grieved. On top of all that, there are multiple types of grief. So we've been talking about, you know, quote, normal grief, if you will, and these are the average expected, whatever. Whatever word. I don't like any of those words. But traditional, I don't know. Help me out here. Feelings that people experience and the reactions and behaviors that they experience in response to any sort of loss. The reactions can be physical. You know, during normal grief. Physical reactions, difficulty sleeping, sleeping, too much difficulty concentrating, lack of appetite. All of those symptoms that we look at for clinical depression actually can occur and often do occur to some degree during the grieving process. So we do want to look for fatigue, irritability, guilt, a sense of Hopelessness and helplessness, apathy, sleep difficulties, changes in eating, those are all expected or not unexpected reactions that we can see out of people. Behaviorally. We may see children, for example, regress behaviorally. Adults may become more irritable, have more difficulty concentrating. When we're in crisis, we're not using those higher order cognitive processes. So things like memory and keeping on top of stuff and organization may go to the wayside. Some people respond in the other direction. And after a trauma, they want to control everything. So, you know, they hold on, hold on to the reins with white knuckles. But, you know, these are not unexpected reactions to grief. Anticipatory grief. Experiencing anticipatory grief may provide time for the preparation of loss, acceptance of loss, the ability to finish unfinished business, do a life review and resolve conflicts. So anticipatory grief, we see a lot in people who've been diagnosed with a terminal illness, for example, they know that they're going to die at some point in the not so distant future. But we can also see anticipatory grief in parents, for example, when they know that, you know, junior is. Or our little kid is a senior in high school this year, that means next year he's going off to college. Oh, my gosh. So you can start anticipating that and get things in order, you know, whatever. Anticipatory grief can be healthy. It can give people a sense of control over what's going on. It can also be overwhelming, consuming, and dysfunctional, depending on the person and the situation. Some people's anxiety is totally wrapped up in anticipatory grief because they're just waiting for the other shoe to drop. They're expecting bad things to happen. They're expecting losses. So they're constantly anticipating this grief, and they're not ever getting to that point of acceptance. They're just kind of preparing for it and holding on for dear life. So we do want to help people get to a point with anticipatory grief where they can breathe and they can say, all right, done what I needed to do, resolved any conflicts. I've prepared everything, I'm as good as I'm going to be. And then we've got complicated grief. And there are multiple types. And knowing all these nuances is not so as important as understanding that grief takes a lot of different faces, if you will. So we don't want to assume that grief is going to look the same for everybody and happen the same way for everybody. Chronic grief, those are normal reactions that don't subside and continue over a very long period. Of time. So we're talking multiple years. My mother's current husband, unfortunately, sweetest man, but he lost his first family in a fire back in the 60s, and he still, and I totally get it, he still grieves over the loss of his family. It's, you know, with however many years that's been, 60 years, it's obviously gotten easier. But right around the anniversary of their death, which unfortunately is Christmas Eve, it's really tough for him. So this chronic grief is there. Now, am I saying that that's pathological or wrong? No, it is. It is what it is. And he has learned to deal with it, so it doesn't overcome him every year. But it's important to recognize that some people will experience chronic grief. Delayed grief are normal grief reactions that are suppressed or postponed order to avoid the pain of the loss. And sometimes people will just kind of pretend it didn't happen. This is especially true with deaths or with finding out that you're terminal, you've got a terminal illness of some sort, or finding out that you've got a chronic illness, people may try to pretend it's not there. It's like, I didn't hear that. In order to avoid having to feel those feelings and go through that grieving process with masked grief, the survivor is not aware that behaviors that interfere with normal functioning are the result of a loss. So sometimes there's a loss and people are like, okay, I'm fine. But we see a marked change in their behavior. We see these grief reactions, the symptoms of depression, the changes in eating, the, you know, whatever symptoms the person is displaying, which are seemingly normal grief reactions, but the person doesn't recognize, they don't see the connection. And that's, you know, a big aspect of trauma informed care is helping people see the connection between their current behaviors, where they're coming from, and what might be have triggered them. And finally, disenfranchised grief is the grief encountered when a loss is experienced and cannot openly be acknowledged, socially sanctioned or publicly shared. And you might be thinking, well, what would that be? For example, if somebody is in a relationship and having an affair, and that relationship ends, that. That affair ends, that may not be something. They can call up their mom and go, hey, you know, the person I was having an affair with just dumped me. You know, that might not be something they can share. So they're sitting there with this grief all by themselves. And, you know, it gets heavy and it's oppressive and it's painful. Sometimes we cannot depend, especially depending on the culture, people may not feel like they're able to share or get support for traumatic experiences, including rape. And so they may feel disenfranchised because even if they did share it, they would get condemned, judged, or it wouldn't be socially sanctioned to be, to be talking about that. So being aware that, you know, sometimes people have losses that society goes, yeah, we don't care. And we need to go, well, the person cares for, for whatever's going on with them, it hurts their heart, so we need to help them. So the stages of grief go back to Kubler Ross. Denial. People have numbness. They may think it's all a dream or they may come up with alternate explanations for what's going on. When people get a terminal diagnosis, maybe it's not cancer, maybe it is, you know, something else and they want it to be something else so much they keep looking for alternate explanations or they just, they don't feel anything. It's just like, you know, they go into a daze for a little while, then anger. And these are not sequential. The unknown. Loss of control. Death, isolation and failure are our threats. When we experience a loss, we almost always experience at least four out of five of these. The unknown. When this loss happens, it's like, okay, our world has been shaken, so we don't exactly know how it's going to shake out. Loss of control. When we're grieving something, it means we lost something that was important to us. Well, if it was important to us, then we wanted to hold onto it. So for grieving it, it means we didn't have control. And as humans, we really don't like that. We want to hold on to those things that are important. It can mean isolation from other people. It can mean isolation because nobody understands your feelings. I worked with a really cool program when I was at UF that worked with people who had recently lost pets. And you know, this was, you know, 20 some odd years ago when pet grief was really not something that was accepted or looked upon as valid. And I've always viewed my four legged friends as part of my family. So working with people who understood, which is why support groups are so helpful because it gets people in a situation where they can feel like, okay, I'm not isolated, I'm not the only one going through this. And after a suicide, for example, some people may feel very isolated. They may be very angry at the person who committed suicide. They may be angry at themselves. They may feel like nobody would ever understand. Which again, goes back to those support groups. Failure. When we have these losses, if you Lost a job, you may feel like you failed. When you lose a relationship, you may feel like you failed at something. So anger often revolves around these shoulda, coulda, woulda's. If I could have done this, or if I would have done this, then I would have maintained control. So people start second guessing themselves and then getting angry. They may get stuck in this turmoil, bargaining. If I do xyz, then I'll wake up and realize this was only a really bad dream. Or let me just wake up tomorrow and this be a really bad dream. Depression, the person starts settling into, okay, this is really happening and I can't change it. I'm powerless, I feel helpless, I feel hopeless. This is a place, you know, along with anger, this is a place where we can really help intervene to help them help people. See, okay, there are certain parts of this situation you are right, you totally don't have control over. However, there are certain parts of this situation that you do have control over. So, you know, let's separate this so you don't feel totally helpless and hopeless. You know, let's look at figuring out what you can focus on and control. What aspect or aspects of your life can you still control with respect to this? For example, when my father died, my kids were, well, my son was really young, my daughter wasn't even born yet. And you know, I felt very depressed and sad that they weren't going to get to meet, meet him and know him and obviously helpless and hopeless because I couldn't fix the cancer and all that kind of stuff. However, I did recognize that, all right, well, for whatever reason, he's not supposed to be here anymore. But I am not powerless to keep his memory alive. I am able to keep his memory alive, talk to my kids about who he was, share stories about him. So there are ways I can have him be a part of my children's life even though he's not physically there anymore. So, you know, helping clients really look at, alright, how can you make the best out of this, if you will. And acceptance, radical acceptance that the loss occurred, it is what it is and determining how to proceed from there. And I know you guys have heard me say this 20 times, unless this is your first class, but I try to encourage clients to think of it like a TV series. And you know, TV series, especially the really good ones, and we'll assume your life is a really good TV series, go on for years. And characters change, characters die off, get killed off or die off, plot lines come, plot lines go. And at the end of every season it closes out and closes a plot line generally. Then the next season says, all right, everything henceforth is going to be informed by the prior seasons. We're not just gonna start out of nowhere. It's gonna be a continuous storyline. But that last storyline, we're done with that. Let's figure out how we're gonna open this new season and make this upcoming season a really rockin set of episodes. So that's what we want to look at. You can also look at it like chapters in a book, depending on the person and what they relate to better. So exacerbating and mitigating factors. How people react in a crisis depends in general on six factors. How close the situation was to them. So their physical and emotional proximity. Now this is really interesting in Today's environment of 24, 7 media coverage where everything is in your face all the. Because it feels like everything is close to you physically or emotionally at all times. And it can be oppressive. Little kids don't understand what they're watching on tv. May be an excerpt of something that happened that's getting played over and over and over again in their mind. It's happening over and over and over again. And it feels like I remember my son was watching the Twin Towers and he was little at that point and. And I remember, you know, talking to him and he couldn't conceptualize where New York was. You know, that was beyond his understanding. It just felt like it was in his living room because it was in his living room. Well, you know, he was three. I don't blame him. So we're looking at how close the situation was and we do want to be cognizant of what's going on. And video games and other things can be. Can make it seem like the world is much more violent in close proximity to you. Many other stressors they experienced in the last year. Obviously my fingers had a little typo there. So if they've had a really good year, then they may have the reserves built up to take a deep breath and work through this. If they have had loss after loss after loss or trauma after trauma after trauma, they may be plumb worn out. So this current crisis may just be totally overwhelming. If they have any other mental health issues either that are symptomatic or even that are in remission, you know, trauma, loss, grief, all of those things can trigger a resurgence of mental health symptoms because it adds a layer of stress which is going to mess with those neurotransmitters, neurochemicals, and keep that threat response system Cranked way up along with mental health skills is, or mental health issues is whether the person has effective coping skills. You know, even if they don't have a history of clinical depression, if they don't have effective coping skills, it's going to be really stinking difficult for them to deal with this crisis, this trauma, this loss potentially. So we do want to look at that because ineffective coping skills may mean that they have a low level of adjustment disorder or whatever you want to call it. But you know, if they don't have effective coping skills, they could develop mental health issues really quickly. Social supports, if they've got good social support, then they have a world of hope. Especially if that social support is available within the first four hours. When stuff is still in that short term memory and the brain isn't quite sure what to do with it and how to assimilate it and integrate it within the first 24 hours is still helpful. After that 24 hour period, social support is still helpful. But you know, we really do need something in there in that first 24 hour period. So social supports, even, you know, a week, two weeks, six months out can be helpful, even if it's just helping with groceries and meals and other things so the person can focus on the grieving process and recouping their understanding of the loss. Now let's start with cognitively. Little children may not understand what's going on, so they're going to react differently than adults who kind of get what death is. Little kids may not understand, you know, why did this happen, that my house burned down, or that my dog died or whatever it is. Adults may not get that either, or they may. And then the meaning assigned to the loss, if the person believes that it is, you know, the path that was supposed to be taken, that's one way of assigning meaning to it. That's going to bring its own emotional stuff with it. Or if they believe it's punishment from a higher power, that may create another reaction. So what, in what way do they understand this loss? Do they understand it as permanent? Do they think it's their fault? All those things that go into it, you know, all your attributions, but then what is the meaning behind it? Why did this happen? And you know, those things will change how people react to loss and how much control or responsibility they feel like they had in the situation. You know, a parent who is at home, you know, folding laundry when the child toddles out and drowns in the pool is likely going to feel a lot more devastation initially because they felt like, you know, they should have been watching. Even the parent that was at work when this all happened may feel like they should have been home or they should have put up a better fence or whatever. You know, there's lots of shoulds after, after a significant loss. So we do want to make sure that people are objectively looking at the big picture and, you know, how much control they really did have. Because hindsight's 20 20. I mean, we can look back and think that, you know, see where we should have been able to control things, but in the moment, not necessarily. Impact of unresolved grief. Most people either get stuck in anger or depression. They don't usually get stuck in bargaining, and some get stuck in denial, but that's fewer. So anger your shouldas, couldas and if onlys. People after a loss are often angry at themselves. This wouldn't have happened if I would have. They may get angry at other people. This wouldn't have happened. If you would have just done this, we would have been fine. Or if you wouldn't have done this, we would have been fine. And they can be angry at their higher power. You know, what am I doing? Why are you letting this happen? And being very frustrated and angry at their lack of control, depression, that sense of hopelessness, helplessness. I just don't know how I can't go on. They can be depressed and feel hopeless within themselves, you know, that they can't change anything and it's hopeless. They may be depressed and I say at others, but they may not feel like anybody else can change it either. You know, don't bother that nothing's going to do any good. There's no way you can help me. Same thing with their higher power, you know, that higher power ain't coming to my rescue. So I am hopeless and helpless. So we do want to look at, you know, either the anger or the resignation at those different dynamics. Denial numbing is the mind's way of protecting people from what lies ahead. So we want to help them face their loss, you know, get out of that river in Egypt and understand that the events in their lives happened and reconcile the losses they've experienced. So encouraging people. And when I do autobiographies with my clients, we go back, we look at the losses that they've experienced and clarify, you know, what was important about those losses, in what ways those losses or those things, whatever it was that they lost benefited them and how that loss is currently impacting them. So they start to understand and recognize how their losses have changed them. But how the things that they lost also change them, hopefully for the better. And we want to help people just really be able to answer the question, what in the world just happened? What happened to cause my paralysis, to trigger the diabetes, to whatever anger I talk about as a power play? Because anger says, I'm angry at you. You failed me. You know, everybody stay away, because I don't trust anything right now. So with anger, sometimes we've got to break down the walls of anger about what's going on. And you may totally disagree with this activity that I do, but, you know, I found it to be relatively effective. We get the big Legos, you know, the ones that they use for toddlers, and people put masking tape on them with the losses that they've experienced. And then we start breaking down the walls, and they actually go through kind of like Godzilla, and they can get their frustration out about, you know, this happened or that happened, or I'm frustrated that all of these things occurred because of the anger. And then we can. Because of the loss. And then we can start talking about it, bargaining. This is also kind of a pining phase. If only, you know, if only I find out that this test was wrong, then I will go to church five days a week for the rest of my life, or whatever it is. During this time. We want to encourage people to use mindfulness and focus on what is right now, Focus on the present moment, what they have, what they are in control of, what their needs are. Then they move into depression, disorganization, and despair. We want to help people address hopelessness and helplessness by focusing on what can be changed. Just because somebody died does not necessarily mean they have to disappear from your life. They can be in your heart. They can be in your memories. Just because you lost something, whether it was a job or a relationship or a family member, doesn't necessarily mean nothing will ever be okay again. So, yes, that loss is terrible, and that's not going to be the same again. But how can things be okay? Failure, you know, doesn't necessarily mean that they failed at everything. You know, if I failed in this relationship, then I'm going to fail at every other relationship, and I'm just failure. So we want to help them reorganize and see this experience as a specific event that occurred. And bad things happen doesn't necessarily mean that bad things have to happen again. So just because one person in your family was diagnosed with cancer or you experienced one hurricane, doesn't necessarily mean it has to happen again. So when people get into that it's going to happen again. They either tend to get anxious or resigned. It's just like, well, screw it. What can I do? It's going to happen again. So we do want to help them address these feelings and thoughts that go along with depression and reorganize their life now, because in depression, they feel helpless and hopeless. Okay, well, let's reorganize around the things that you can control. Children who go into foster care also go through these very same steps when they are taken from their home. They go through the denial, the anger, the bargaining. They reach depression, and it manifests in a variety of different ways. Acceptance is this reorganization phase where we redefine the worldview, integrating new experiences and strengths. So we're saying, all right, we came out the other end, you know, we pulled the curtains up. The storm is gone. Now what? Who am I? What is my new identity? Where am I going? You know, who am I attached to? What am I attached to? Where. What's important to me? How will I get there? What relationships do I need to help me get there in the future? What social support do I need? And when will I know that I belong? When will I know that I've been accepted and that I am on the right path? So when will I know I'm safe again? And those are questions. You can change the wording on them a little bit, but we really want to help people figure out where to next and exactly what that's going to look like, you know, a little bit. You know, in general, what is going to look like six months, a year, five years from now? But definitely, what is that going to look like next week? You know, who are you? Where? What do you need? What are you doing? What's the next step? How are you going to get there? And when will you know that you've. You've achieved that? Most people experience grief surrounding a loss for at least a year. Holidays, anniversaries and reminders. Sometimes I'll have clients do a timeline. And this is preventative. This is not retrospective necessarily. So they can look and see, you know, if the. If a loss happened a long time ago, then sure, they can look back and go, okay, these are the times of year that typically feel triggered. If it's a new loss, you know, doing this timeline. So they can say, okay, these are the times of year that, you know, I really associate strongly with this person, place, or thing. So they can start making a prevention plan. Many people will vacillate between depression and anger when they're dealing with the grief process. So we need to normalize their experiences. You know, they don't just move through one and they're done with it. You know, sometimes they'll go back and forth, and sometimes that sadness, that, that grief, that despair will just kind of bubble up out of nowhere. And you're like, wait, I thought I was past this. Normalize their reactions, normalize their experiences. Encourage them to reach out to supports and make sure to remember to address happiness and survivor guilt. Some people feel really guilty being happy during a crisis or a trauma, and some people feel guilty for surviving, you know, if there was a fire or a car accident or something else. So these are things that we want to make sure people don't develop guilt on top of the grief. Self care emotionally. Encourage people to express their feelings, ask for and accept help. Don't let anyone tell them how they should feel. And encourage them not to tell themselves how they should feel. Remember that mindfulness and radical acceptance. I feel how I feel, and what can I do to improve the next moment? I'm not going to fight with it. It's how I feel. What's the next step? Be patient. Be kind to yourself. Encourage them to add happiness triggers into their life. Encourage them to listen to comedians. Encourage them to do things that make them happy during this grief period, even if, you know they're living in a shelter. After Katrina, people were in shelters for months and months and months. And I would go into the shelters and I would bring activities for the kids to do and, you know, stuff for parents to do with their kids. And we would try to do. We would watch movies sometimes. You know, there are a variety of things that I would bring into the shelter in order to make people feel a little bit more relaxed. Was it going to be gleeful? No, probably not. But we want to add things that help people feel a little bit happy during the holidays. Making sure to go in and bring holiday decorations that represent the cultures that are present. Encourage people to be aware of their grief triggers. And that can include, remember all of the senses, what they see, what they hear, what they smell. And encourage them to embrace the dialectic. It's gone, but I have the memories. I have what I learned. So this relationship is over, but I learned a lot from it. You know, this relationship is over. And this was my one true love. But not everybody ever gets a one true love, so at least I had that. You know what? However, the person wants to embrace that dialectic, and I leave that up to them because I don't want to invalidate the first part, their current feelings. I cannot change it, but I can impact how it continues to impact me. And that's the thing, we can't change whatever the loss was. But people do have the ability to decide how it's going to impact them henceforth and forevermore. Physically, people need to get plenty of quality rest, which means they need to be able to handle being alone with their thoughts. And when they lie down at night to close their eyes can be some of the most haunting times. So we want to help them figure out how to do this. And there are a lot of techniques for helping people do progressive muscular relaxation, mindfulness activities, meditations to help them kind of quiet their mind. It's going to depend on the client, what needs to be done. Encourage people to exercise, eat a healthy diet and avoid alcohol because all of these things are going to contribute to neurotransmitter stabilization, good sleep, good health, and potentially physical and emotional recovery. And encourage them to pay attention to persistent changes in eating, sleeping and mood or energy levels. Again, I normalize this, you know, the first couple of weeks after a trauma, I'm not surprised if these things are out of whack. But if they persist or if they become untenable, then, you know, reach out by all means. Psychologically, higher order thought processes, they're not engaged right now. You're in a crisis state, so the body is focused on survival. So encourage people to write things down because their memory is going to be crap. Simplify things, you know, instead of making a five course meal, order in. Encourage people to set short term goals. This will help them start redeveloping that self efficacy. Encourage them to distract or engage in pleasurable activities and start writing the next chapter in their story and plan ahead for grief triggers interpersonally. Encourage people to rebuild relationships, even understand that they can be members of more than one family. So after a child is removed from their home, you know, they have their biological family, but they also may have their adoptive family and they could feel like they're betraying their biological family or vice versa. So encourage them to recognize that, you know, it's not, doesn't have to be either. Or after a divorce, the same thing can be true. You can have, you can still both be friends with the same people. The Bill of Rights for grief and I give this as a handout to my clients. They have the right to know the truth about loss, have questions answered honestly, to need people, and be heard with dignity and respect. They have the right to be silent and not talk about griefs. Emotions and thoughts. Sometimes it's just that time. They have the right to talk about the loss as much as needed and to not agree with your perceptions and conclusions. It's theirs. They have the right to see the person who died and the place of death, obviously, if it's a death. They have the right to grieve any way he or she wants without hurting themselves or others, you know, and they have the right to feel all the feelings and to think all the thoughts of his or her own unique grief. To not follow the stages of grief as outlined in the book. To grieve in one's own unique, individual way without censorship. To be angry at death or loss, at the person who died, at God, at self and at others. To have grief bursts. And that's where that overwhelming feeling just kind of comes out of the blue sometimes. To be involved in decisions about the rituals related to the loss, to not be taken advantage of and to have guilt about what he or she could have done or should or shouldn't have done. So each one of these we go through in individual counseling to make sure that people feel like they're getting their rights heard and respected. So activities, and I know we're running short on time here. Create safety. You know, that's the first thing. Talk to the person about, what do you need to feel safe if it's a foster child, what do you need to feel safe in this environment? You know, structure is going to be one of those things. A bed that's their own, a drawer, if not an entire dresser. You know, those sorts of things will make them feel like they've got a place. Creating safety. For someone who is living in a shelter, we want to make sure that they have their own space that's not invaded, that they have, you know, a sense of physical safety. There are a lot of things that we can do. Invisible string is an activity that you can do. And I like the one with terracotta pots. But you can do it with wind chimes, hearts, shells, keys, pipes, anything that you can string up. But if you have the invisible string and it's holding those things, then when they ring in the wind, it reminds you of that person. You can make a book of memories, a heartbreak pot. Now, this is one of my favorite activities. You take a pot, and I usually get a big terracotta pot, not one of the little ones, and you break it into large pieces using paint, pens and markers. Each family member or child writes on the inside of the broken pieces. Their feelings about being alone in their grief on the outside of the pieces they write about or draw their sources of support, and then they glue it back together so they have the support on the outside and the grief and what it feels like to be alone with their grief on the inside. They can write a goodbye letter, a letter to God. They can make a memory garden. So every year they plant a plant or a tree in memory of that person. They can keep a jar of memories or regrets that have to do with that, whatever that loss is. I like the jar of memories because that's positive and, you know, funny things that you remember about that person. So when you're having a grief moment, you can go back and you can review those things and go, oh, my gosh, I had forgotten about that. You can create a memory mural, you know, on a. On a wall. You know, that that is either pictures or drawings. You can have a timeline of change that indicates, you know, what you learned when you met that person or encountered that thing, what you learned and when the separation occurred and the changes that have happened. You. I do two box organization. Two boxes. I usually use pencil boxes. I have people write down their thoughts about a certain loss that they've had, and then they evaluate that thought and they go, is this one I want to hold on to? Or is this one I want to let go? And it's keep it or trash it. And we're going to clear out that mental clutter that talks about what they should do or shouldn't or grief or regret. This is when they start going through those thoughts and getting clarity on what happened. They can create a family flag if their home was destroyed or something. They can create a flag of unity. You can do my favorite activity, the Alphabet. Alphabet of gratitude, another one that you can do. And this is a little touchy sometimes, but most of the time, the butterflies are really easy to release. You raise and release butterflies because just like the caterpillar, you know, goes through life and he's happy as a clam, then all of a sudden you, you know, he has to change and he morphs into something else. And there's that period when he's in his cocoon, like our grieving period, where we're adjusting to what we're becoming, but he becomes something equally as awesome. Jenga on cards, or you can write them on the blocks. You can write different prompts to encourage people to discuss their loss, such as what's their favorite memory? What's something they learned? Who's their support right now? What are two things that help them most right now? The hardest time of day is so all those things, you can either do it on a beach ball or on Jenga blocks. So losses encompass more than a death of a person or loss of property. Failure to acknowledge losses can cause unhelpful reactions in similar future situations. So if you've been through a hurricane before and your house was devastated, then if it gets stormy during hurricane season again, you may start having resurgences of that grief reaction. It's important to explore feelings and reactions in terms of their functionality and how they're benefiting the person. How are these feelings, reactions, behaviors protecting you in some way? It takes at least a year for people to deal with significant losses. Many times there are multiple secondary or ancillary losses that also need to be addressed. How people deal with grief and loss varies widely, and we need to remember that grief is a form of crisis. It's that emotion that's going on when we are adjusting to a change. The body is on high alert during this crisis period, which impacts sleep, eating and energy to work or socialize, as well as memory and concentration. Minimizing vulnerabilities by getting enough sleep, exercise, proper nutrition, doing a little bit of fun stuff is important to reduce unnecessary frustration and avoid confirming helplessness. Ultimately, it's hope that the person can identify how they're stronger or better off from the experience. Alrighty. Thank you for bearing with me. There weren't a whole lot of new exercises in there, but you know, I think it's a good reminder that there are a variety of activities that we can do and a variety of things that can cause grief and trauma in people. So remember, the PDF of the PowerPoint is available in your classroom. You can download that, your quiz is available and you can. Take the quiz whenever you want. I'm sorry to hear about your dog, Bill. That's sad. Alrighty everybody. I will see you on Thursday. If this podcast helps you help your clients or yourself, please support us by purchasing your ceus@allce.com or getting your agency to sponsor an episode. 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